Why I got rejected by 3 top tier clinics

[iKelia]

Hello everyone,

    I'm 32 years old. I have a receding hairline. All of receding happened when I was 16-18 old, the so-called puberty period. Both my father(55 years olds) and my grandfather(75 years old) have a receded hairline at the temple areas, like mine. Their state doesn't differ much from mine at their senior age. Based on that I guess that my receding is already stagnating for a long time. 
    Last year I got really concerned about my appearance and committed to do something about it. I stumbled on your forum, started researching the subject. 4 months ago, I started taking finasteride and 1 month ago applying minoxidil solution. 
I've sent enquiries to several major top tier clinics from hairrestorationnetwork recommendation list and was getting ready for a surjery. However 3 of them rejected my case, wording it as I don't need hair transplant procedure. I got really discouraged after this because the subject seems to become very controversial.  Most of them claimed I will need 1500-2500 if i decide to pursue this matter.
 
Next pictures are meant to highlight my expectations: 



One clinic cautioned me that I don't get a natural hairline after HT, it will always be either too dense or too sparse. And even, they more warned me to not get carried away with some clinics who promise me otherwise.
Is that true?  

Another one said that my hairline is only slightly accentuated, it might not even be operated on. And claimed I can possibly improve my condition by taking oral minoxidil 5mg along with finasteride 1mg. 
What can I expect by following this regimen? Does it promise 80, 90% restoration? Or will it thicken miniaturised hairs to the level of fully grown adult hair? 

Another clinic stated that implanted hair, based on their own personal experience lasts at least 15-20 years. 
Is that real? I thought the hair from the back of the scalp is highly resilient and lasts till the end of his life.  

All of them claim that I will have to take finasteride + minoxidil medication forever. I assumed it's just a general recommendation.  
However, I would like to clarify if it's still a necessity in my case based on my inheritance traits I've layed out in the begging of the post about my dad and his dad having the same hairline pattern at their old age as I do have right now. And also, my receding has been stagnating since my puberty period.  
  

Next picture is a preliminary design from one clinic. I worry what they gonna use too much grafts because they claim they try to cover the empty spots in the area above the hairline which looks totally normal to me. And 2000 is the half of my donor area reserve.
 

  






  

[Rafael Manelli]

Your hair looks great. Meds will not restore a receded hairline though. They will at best thicken diffuse thinning. But they won’t undo recession.

The hairline you drew looks too low to me. Too aggressive. Try using the rule of thirds. Try raising the hairline by 5mm to 10mm from where you’ve drawn it. You may not even need to bring down the centre point at all.

do you have any photos of before you had loss?

[A_4_Archan]

@iKelia yeh its seems you dont need hair transplant ...start medication and see how it appears after 6 months..u cn also consider prp if ur hair on the top are geting fine...thn aftr 6 months u think tht u still need a transplant thn too dont lower ur hair so much .. That would look unnatural ...jst lower a bit and cn work on ur temples a bit and u r all done...

[iKelia]

7 minutes ago, Rafael Manelli said:

Your hair looks great. Meds will not restore a receded hairline though. They will at best thicken diffuse thinning. But they won’t undo recession.

The hairline you drew looks too low to me. Too aggressive. Try using the rule of thirds. Try raising the hairline by 5mm to 10mm from where you’ve drawn it. You may not even need to bring down the centre point at all.

do you have any photos of before you had loss?

Thank you ! Unfortunately, I won't be able to find any quality photos with head profile from 16 years ago we didn't have digital cameras that time ( 
   
Center point for me is a point where the last fully grown living hair follicle of mine sits. I use it as a base and draw horizontal line across it to make my face appear like it's having somewhat straightish hairline. Because that's how I perceive myself being of the age when i was young.  
Also a couple friends of mine have a straight hairline when looking at their face from the front and I quite enjoy the look. 

     

[Rafael Manelli]

In that case you can move the hairline up just a few millimetres at the middle, maybe 2 or 3, from where you've got it. That guy in the photo you posted seems to have a higher hairline than the one you've drawn on you, but it is straighter and flatter. 

Your temple points retain their original shape. They're not receded. At worst they're thinning. Finasteride could stop this. They do not need transplanted, or at most, they need about 100 grafts but only for density, not to advance the shape and position.

You could probably restore all the loss on the front corners for only 1000 grafts. 

This would leave you with a youthful Norwood 1 hairline, this is risky in the long run because you may continue to lose hair behind the grafts. So use meds.

 

Your other option is to go for a more conservative hairline, which saves grafts. But guess what? You already have that. 

[HappyMan2021]

what are the specific names of the clinics that rejected you? I do think you would qualify for a minor hair transplant. 

I don't understand why you were rejected. 

Edited January 31, 2023 by HappyMan2021

[HappyMan2021]

9 minutes ago, iKelia said:

Thank you ! Unfortunately, I won't be able to find any quality photos with head profile from 16 years ago we didn't have digital cameras that time ( 
   
Center point for me is a point where the last fully grown living hair follicle of mine sits. I use it as a base and draw horizontal line across it to make my face appear like it's having somewhat straightish hairline. Because that's how I perceive myself being of the age when i was young.  
Also a couple friends of mine have a straight hairline when looking at their face from the front and I quite enjoy the look. 

     

 

do keep in mind that Matthew Mcconaughey wears a wig, so he is not the best person to use for a hair transplant example.

[iKelia]

13 minutes ago, Archan said:

@iKelia yeh its seems you dont need hair transplant ...start medication and see how it appears after 6 months..u cn also consider prp if ur hair on the top are geting fine...thn aftr 6 months u think tht u still need a transplant thn too dont lower ur hair so much .. That would look unnatural ...jst lower a bit and cn work on ur temples a bit and u r all done...

Thanks for the advice! I start researching different Mesotherapy options like PRP, PRF.  Do you think I should stick to PRP? 

When I try to match 1 to 1 with a Norwood scale my profile picture then I definitely see highly elevated and receded temples and look like Norwood 3 to me: 

[asterix0]

The hairline you want is too low and will look unnatural. Your hair is fine and I wouldnt chase perfection with this whole process. 

[A_4_Archan]

@iKeliayou temples looks well from ths pics and the hairline u r considering would look unnatural from my point of view...better keep it a bit upward and it will look more natural..u cn consult dr munib ahmad ..he is producing really great natural results...whr r u from ?

 

[NegativeNorwood]

It's hard to judge hairline height without seeing the rest of your face in a non lens distorted picture.

All the face must be taken into account to establish hairline height. Ideally, it should be the same as the midface lenght. The best way to measure is with a tape or digital caliper, from the lowest part of your hairline to the glabella (middle of the inner eyebrows), and compare it to the lenght from the middle of your eyebrows to the end of your nose. This pic provides a good illustration:

 

To me the hairline also looks a bit aggresive at first sight. You have amazing temples, which help a lot in giving the illusion of a lower set hairline. Maybe you can achieve the effect you want with a less aggressive hairline...I don't know, to be honest.

Very good thread, hope to also read more responses. I also have this exact same doubt:

"Another one said that my hairline is only slightly accentuated, it might not even be operated on. And claimed I can possibly improve my condition by taking oral minoxidil 5mg along with finasteride 1mg. 
What can I expect by following this regimen? Does it promise 80, 90% restoration? Or will it thicken miniaturised hairs to the level of fully grown adult hair? "

 

Edited January 31, 2023 by NegativeNorwood

[iKelia]

1 minute ago, HappyMan2021 said:

 

do keep in mind that Matthew Mcconaughey wears a wig, so he is not the best person to use for a hair transplant example.

That was just an example. I have a couple of friends who have the same hairline design which is inherent. They never underwent any HT.  

[Curious25]

You’d be a good candidate in my eyes if you commit to

a) continue with medication,

b) learning more about hair loss and hair restoration. 
 

Your hair line design with the black line is EXTREMELY aggressive, and would possibly require up to 3500 grafts to achieve the density that would be required in order to make it look somewhat natural. 
 

The hairline design drew with the green line is closer to what would be a much more suitable, yet still enhancing intervention. 

[Marlo]

Some of the responses you received sound a bit strange to me. Which clinics specifically did you contact? 

[HappyMan2021]

Can you please state the names of the clinics that rejected you? 

All of the comments here are pretty much speculation. If we know the specific surgeons who rejected you that will add a lot of color to your situation and give alot more info.

[iKelia]

1 minute ago, HappyMan2021 said:

Can you please state the names of the clinics that rejected you? 

All of the comments here are pretty much speculation. If we know the specific surgeons who rejected you that will add a lot of color to your situation and give alot more info.

Clinica de Freitas - they were actually very helpful and their feedback was more like a recommendation and not an absolute decision. And they're open for HT if I'll insist,
Cyprus HDC Hair Clinic - they just left me without any clarifications as for their decisions cutting my followup questions,
ASMED - Ankara - Erdogan - gave a polite rejection. However after my follow-up there I described my expectations, they re-qualified me for HT with 2000-2400 grafts.  

[iKelia]

1 hour ago, Rafael Manelli said:

In that case you can move the hairline up just a few millimetres at the middle, maybe 2 or 3, from where you've got it. That guy in the photo you posted seems to have a higher hairline than the one you've drawn on you, but it is straighter and flatter. 

Your temple points retain their original shape. They're not receded. At worst they're thinning. Finasteride could stop this. They do not need transplanted, or at most, they need about 100 grafts but only for density, not to advance the shape and position.

You could probably restore all the loss on the front corners for only 1000 grafts. 

This would leave you with a youthful Norwood 1 hairline, this is risky in the long run because you may continue to lose hair behind the grafts. So use meds.

 

Your other option is to go for a more conservative hairline, which saves grafts. But guess what? You already have that. 

"move the hairline up just a few millimetres at the middle, maybe 2 or 3, from where you've got it"
This makes sense to me considering 1/3 to 1/3 ratio and I starting to get the aesthetics of it. However, I'm not making this up, there, at a blue cross resides a fully matured hair sticking out without siblings to hand out with. I consider it to be a base level of my inherent hairline design which I used to have when I was 17 old. 



"restore all the loss on the front corners for only 1000 grafts".
I'd love to have this option suggested by any clinic. That's very conservative.   
Can clinics be trusted with their projected number of grafts? Can they abuse the number to inflate the price? Because there's a huge spread among evaluators. 
Only keser clinic was on the lower end of projection. They gave 1500 grafts based on my pictures. 

"This would leave you with a youthful Norwood 1 hairline, this is risky in the long run because you may continue to lose hair behind the grafts. So use meds."
I hope I will not based on my family history. Is it relevant or am I putting to much hope into it? 

[Rafael Manelli]

What do you think about this line? It would still look good, but for potentially half the grafts. Surgeons may feel this option to be more ethical and less risky.

[iKelia]

23 minutes ago, Curious25 said:

You’d be a good candidate in my eyes if you commit to

a) continue with medication,

b) learning more about hair loss and hair restoration. 
 

Your hair line design with the black line is EXTREMELY aggressive, and would possibly require up to 3500 grafts to achieve the density that would be required in order to make it look somewhat natural. 
 

The hairline design drew with the green line is closer to what would be a much more suitable, yet still enhancing intervention. 

Why is it so many? 
Just randomly picking a recent HT result from another branch of the forum give me next:

They covered a huge are with only 3100 grafts and hairline look very natural and dense to me.

[Rafael Manelli]

Go on YouTube and look up Dr Couto / Fuexpert. You'll find a bunch of results that are aggressive, youthful, and appear dense without using all that many grafts. He tends to show off patients who have a high hair:graft ratio. It's possible. It can be done in the right circumstance. See what you think of those designs. And check out Feller and Bloxham on YouTube too, good showcases there. 

Try using the rule of thirds and see where that would put your hairline. 

[Rafael Manelli]

1 hour ago, iKelia said:

That was just an example. I have a couple of friends who have the same hairline design which is inherent. They never underwent any HT.  

This is a great hairline. A surgeon may recommend against this hairline for a young man due to concerns for future loss, and I think the one you've drawn for yourself is MORE aggressive than this. Too flat. 

I may be wrong. It would help if you uploaded a photo of yourself that's more straight on, including the whole head (blur the face if you wish) 

 

[TheGreatPretender]

I can see why. 

You look great, honestly I doubt anyone would be able to tell you have hair loss and if you add Finasteride to the mix you have hair for life. 

[iKelia]

13 minutes ago, Rafael Manelli said:

This is a great hairline. A surgeon may recommend against this hairline for a young man due to concerns for future loss, and I think the one you've drawn for yourself is MORE aggressive than this. Too flat. 

I may be wrong. It would help if you uploaded a photo of yourself that's more straight on, including the whole head (blur the face if you wish) 

 

Here also, can be clearly seen that front corners are asymmetrical: 
 

This man here doesn't have gaps in front corners, so his hairline look straight, even rounded. I want to have something close to his:



 

[Rafael Manelli]

Okay. I get what you mean. Are you sure this is the hairline you had before any loss? If so, if it looked natural before, it can look natural again. But it’ll take 2000 grafts, give or take.

[HappyMan2021]

i honestly think your HT desires are perfectly reasonable. While your hair is completely fine now, I see why you want it altered. 

Also consider there are significant # of HT patients who do not have MPB, but simply have a large forehead and want more hair to cover it.

So you don't need to have MPB even to qualify for a HT.